Causes and Treatment of Otitis Media with Effusion (OME)
Causes of OME
Otitis media with effusion is primarily caused by poor eustachian tube function, which leads to fluid accumulation in the middle ear without signs or symptoms of acute infection. 1 The condition may occur spontaneously or as an inflammatory response following acute otitis media (AOM).
Key factors contributing to OME development include:
- Eustachian tube dysfunction (primary cause)
- Previous episodes of acute otitis media
- Upper respiratory tract infections (URTIs) 2
- Adenoid hypertrophy causing mechanical obstruction 1, 3
- Risk factors that predispose children to OME:
OME is extremely common in children, with approximately 90% experiencing at least one episode by age 2 years 1. Many episodes resolve spontaneously within 3 months, but about 30-40% of children have recurrent OME, and 5-10% of episodes last 1 year or longer 4.
Diagnosis
Diagnosis of OME relies primarily on clinical assessment:
- Pneumatic otoscopy is the recommended primary diagnostic method to assess tympanic membrane mobility 1
- Tympanometry should be performed when diagnosis is uncertain, with a Type B/flat tympanogram indicating high probability of middle ear effusion 1
- Nasal endoscopy is only indicated in cases of unilateral OME or when obstructive adenoid hypertrophy is suspected 3
Treatment Approach
Watchful Waiting (Initial Management)
The American Academy of Otolaryngology-Head and Neck Surgery recommends a watchful waiting period of 3 months from the date of effusion onset or diagnosis before considering intervention, taking advantage of the favorable natural history of OME. 1
During this period:
- Regular follow-up using pneumatic otoscopy or tympanometry to monitor the effusion 1
- Age-appropriate hearing testing should be performed if OME persists ≥3 months 1
- Optimize the listening-learning environment by:
- Getting within 3 feet of the child before speaking
- Reducing background noise
- Using visual cues when speaking
- Considering preferential classroom seating 1
Medications
The following medications are NOT recommended for OME treatment:
- Antihistamines and decongestants (ineffective) 4, 1, 5
- Systemic antibiotics (not effective for long-term management) 1, 5
- Intranasal or systemic steroids 1, 5
- Mucokinetic agents 3
Surgical Intervention
Surgical intervention should be considered when:
- OME persists for ≥3 months with documented hearing loss (16-40 dB HL) 1
- Structural damage to the tympanic membrane or middle ear is present 1
- Speech, language, or learning problems are suspected 4
Surgical options based on age:
- For children <4 years: Tympanostomy tubes alone 1
- For children ≥4 years: Tympanostomy tubes, adenoidectomy, or both 1
Adenoidectomy enhances the effectiveness of tympanostomy tubes and reduces the need for future operations by 50% in children ≥4 years old 1, 3.
Post-Surgical Care
- Follow-up every 4-6 months to ensure tubes remain in place 1
- For ear infections with drainage, use antibiotic ear drops rather than oral antibiotics 1
- Routine water precautions are not necessary for children with tubes 1
Special Considerations
More prompt evaluation and earlier intervention are recommended for children with:
- Permanent hearing loss
- Speech/language delay
- Autism spectrum disorders
- Craniofacial disorders
- Down syndrome
- Developmental delays 1
Emerging Treatments
Recent research shows promise for autoinflation devices as a non-surgical treatment option during the watchful waiting period. A 2025 study demonstrated that 86% of patients with hearing loss exhibited improvement after 4 weeks of using an autoinflation device 6.
Complications of Untreated OME
If left untreated, chronic OME can lead to:
- Conductive hearing loss (approximately 20% of affected ears have hearing levels exceeding 35 dB HL) 1
- Structural changes in the tympanic membrane 1
- Retraction pockets, atelectasis, and potential cholesteatoma development 1, 3
- Potential impacts on language and behavioral development 3
The management of OME requires careful monitoring, appropriate timing of interventions, and consideration of the child's individual risk factors to prevent long-term complications while avoiding unnecessary treatments.